Coco-Martin Rosa M, Belani-Raju Minal, de la Fuente-Gomez Daniel, Sanabria María R, Fernández Itziar
Instituto Universitario de Oftalmobiología Aplicada (IOBA), Universidad de Valladolid, Campus Miguel Delibes, P° de Belén n° 17, 47011, Valladolid, Spain.
Red Temática de Investigación Cooperativa en Salud de Oftalmologia (Oftared), Instituto de Salud Carlos III, Madrid, Spain.
Graefes Arch Clin Exp Ophthalmol. 2021 Jan;259(1):81-92. doi: 10.1007/s00417-020-04795-5. Epub 2020 Jun 20.
This study aims to determine the probability of progression of myopic maculopathy according to age.
This is a longitudinal observational study of single-center retrospective cohort of Caucasian patients formed by 212 consecutive adults with high myopia. Main outcome measures were age, visual acuity (VA), refractive error (RE), follow-up time, and the macular status assessed at least 5 years apart according to the Meta-Analysis of Pathologic Myopia Study Group. The progression rate was calculated based on per 1000 eyes/year. Multistate models were fitted to identify the predictive factors and to calculate the most probable age of progression onset using the Aalen-Johansen estimator.
We studied 220 eyes of 122 Caucasian patients. Mean age was 48.18 ± 14.1, mean follow-up 12.73 ± 5.81 years. One-hundred and fifty-two (69.1%) eyes progressed of category, and 96 (44%) worsened a mean of 0.3 logMAR units during follow-up. The progression rate was 32.21/1000 eyes/year. The probability of progressing increased with age; it was higher in women if there was a family history of myopia, worse VA, higher RE, or wide macular staphyloma. The probability of progressing from category 1 was > 0.6 after 70 years of age; from category 2, it was 0.7 after 70 years; and 0.5 from category 3 after 75 years. If choroidal neovascularization (CNV) appeared, this probability exceeded 0.7 between ages 45 and 55 for all categories.
The progression rate is lower than in a Japanese series. The vision worsened with disease progression, and the probability of both happening increased after the age of 70-75. If CNV appears, the risk of progression is very high at the age of 45-55.
本研究旨在根据年龄确定近视性黄斑病变进展的概率。
这是一项对212例连续的成年高度近视白种人患者进行的单中心回顾性队列纵向观察研究。主要观察指标为年龄、视力（VA）、屈光不正（RE）、随访时间，以及根据病理性近视研究组的荟萃分析，至少相隔5年评估的黄斑状态。进展率按每1000眼/年计算。采用多状态模型来识别预测因素，并使用Aalen-Johansen估计量计算进展开始的最可能年龄。
我们研究了122例白种人患者的220只眼。平均年龄为48.18±14.1岁，平均随访时间为12.73±5.81年。152只眼（69.1%）病情进展，96只眼（44%）在随访期间平均恶化0.3个对数最小分辨角（logMAR）单位。进展率为32.21/1000眼/年。进展概率随年龄增加；如果有近视家族史、视力较差、屈光不正较高或黄斑葡萄肿较大，女性的进展概率更高。70岁后从1级进展的概率>0.6；从2级进展，70岁后为0.7；75岁后从3级进展的概率为0.5。如果出现脉络膜新生血管（CNV），所有级别在45至55岁之间该概率超过0.7。
进展率低于日本的系列研究。视力随疾病进展而恶化，70至75岁后两者发生的概率均增加。如果出现CNV，45至55岁时进展风险非常高。
